Facilitating Endotracheal Intubation in Difficult Cases Using an External Magnet

Abstract

Difficult airway is conventionally defined as a medical scenario in which a trained examiner faces difficulty in either facemask ventilation or tracheal intubation (1). Unlike difficult intubation, the incidence of difficult mask ventilation in adults is considerable (2, 3). Anesthesiologists and those who practice intubation should be familiar with the management of airway and be able to recognize and identify potentially difficult airways including congenital craniofacial deformities with micrognathia (e.g. Pier Robin, Treacher Collins, Goldenhar's, and Crouzon's syndromes) and metabolic diseases causing the deposition of accumulated by-products (e.g., Hurler's, Morquio's, and Beckwith-Wiedemann syndromes). Cormack and Lehane grades 3 and 4 at laryngoscopy are an indication for advanced techniques for intubation. Laryngeal mask airway (LMA) and fiberscope with a directable tip are useful and important modalities in handling difficult airway and intubation (5).

Even normal pediatric airway could become critical due to the anatomical and physiological differences between pediatric and adult airway; this particularly becomes a concern in infants, i.e. children younger than one year old. This hazard is augmented in the presence of congenital or acquired difficulties affecting airway. Consequently, proper preoperative assessment is considered as the cornerstone of pediatric difficult airway management. Every anesthetic plan should be tailored according to patients considering the scenario and also the expertise of the practitioner. Opting for spontaneous respiration maintenance and intervening in a step-wise manner are strongly suggested (6).

Multiple airway devices have been and are developed that all of which can be placed under direct vision or blindly; most of these devices consistently both provide and maintain safe oxygenation and ventilation. Furthermore, a wide range of ancillary devices have also been introduced to be of assistance in the management of difficult airway; most of them are available in varied sizes suitable for use in children and incorporate a variety of different types of endotracheal tubes, supraglottic devices, fiber-optic, video, optical, and mechanical technologies. Some of these devices (e.g. video laryngoscope) are expensive and not suitable for developing countries with limited financial reserve; some others need high levels of experiences  or learning courses which is not possible for anesthesiologist that are not working  in university hospitals or are less experienced. Some of these devices cannot be used in small children or neonates. Therefore, we were encouraged to look for a device that is easy to use and carry, inexpensive, small in size, and available in all sizes for children, and also does not need special training.